Methods and Devices For Treating Intervertebral Disc Disease

ABSTRACT

An aiming plate for orienting tools toward target features of an implant. The aiming plate features a first and a second surface and has a reversible attachment mechanism for attaching to an implant to orientate one of the first and second surfaces to face the implant. The aiming plate also features first and second through holes. The first through hole for receiving a tool extends along a first hole axis from the first surface to the second surface. The second through hole for receiving a tool is positioned adjacent the first through hole and extends along a second hole axis from the first surface to the second surface. The through holes arranged so that the first hole axis is divergent with respect to the second hole axis.

CROSS REFERENCE TO RELATED APPLICATIONS

This application is a Divisional Patent Application of Utilityapplication Ser. No. 13/089,846, filed Apr. 19, 2011, that claims thebenefits of priority under 35 U.S.C. §119 and/or §120 from prior filedU.S. Provisional Application Ser. No. 61/325,913 filed on Apr. 20, 2010,which applications are incorporated by reference in their entirety intothis application.

FIELD OF THE INVENTION

The present invention generally relates to an aiming device for guidinga drill bit during the drilling of a hole in a bone. More particularly,the present invention relates to an intramedullary nail aiming devicefor drilling holes in a bone that are suitable for receiving lockingscrews of an intramedullary nail. Exemplary embodiments of the inventionrelate to a system comprising an intramedullary nail aiming device andan intramedullary nail and to a method for drilling the holes in a bonefor inserting locking screws in an intramedullary nail by using theintramedullary nail aiming device.

BACKGROUND

Intramedullary nails including fixation screws inserted through theintramedullary nail in a transverse direction to lock the intramedullarynail relative to the bone are commonly known. In particular, proximalhumerus nails comprise multiple fixation screws arranged at differentangles relative to each other in the proximal part of the intramedullarynail to securely fixate bone fragments.

These screws are positioned in the intramedullary nail in correspondingthrough holes using an aiming arm or aiming block rigidly connected tothe proximal end of the intramedullary nail by an intermediate member.These aiming blocks feature guiding holes aligned with the through holesin the intramedullary nail but arranged at a distance from the bone toleave space for the arm and shoulder of the patient. Generally, drillingor guiding sleeves are inserted into the holes in the aiming blockdrilling tools and screwdrivers guided through the sleeves are exactlyaligned with the holes in the intramedullary nail. For anatomicalreasons, intramedullary nails are commonly provided in “left” and“right” embodiments, i.e. in a mirrored configuration. Therefore, theaiming blocks generally feature through holes matching the left side andthe right side configurations of the intramedullary nail. Because aimingblocks which preferably include radiolucent carbon fibre reinforced PEEKmaterial are very costly, it is preferred to have only one aiming blockfor both configurations of the intramedullary nail. Known aiminginstruments comprise aiming blocks with all the through holes for theleft side and the right side configurations of the intramedullary nailin a single aiming block. These known aiming blocks can pose the riskthat the wrong through holes may be used when preparing the bone, i.e.drilling the holes in the bone through which the fixation screws will bepositioned. For example, a user may inadvertently drill through a holecorresponding to the “right side” configuration of the aiming devicewhile working with a “left side” intramedullary nail. If a wrong hole isselected the drill bit will collide with the intramedullary nail andcause unacceptable debris possibly resulting in a loss of stability ofthe intramedullary nail and furthermore, an unnecessary hole drilledinto the bone. In order to prevent this, the through holes in the aimingblock are clearly marked “left” and “right” or are colour coded. Instressful situations, however, mistakes may still be made.

German Patent No. DE 101 10 246 C2 ERHARDT discloses an aiming devicefor a tibial locking nail which can be used for placing locking screwsfor the left as well as for the right tibia using the same device.However, the tibial nail used with the system of ERHARDT is of thesingle type and does not have different left and right side shapes.

SUMMARY OF THE INVENTION

The present invention relates to an aiming device and method forproperly guiding a tool or instrument in case of a left side and a rightside configuration of locking screws to be inserted in an intramedullarynail by clearly preventing from using or even making it impossible touse a wrong hole.

In a first aspect, the present invention is directed to an aiming platefor orienting tools toward target features of an implant. The aimingplate features a first and a second surface and has a reversibleattachment mechanism for attaching to an implant to orientate one of thefirst and second surfaces to face the implant. The aiming plate alsofeatures first and second through holes. The first through hole forreceiving a tool extends along a first hole axis from the first surfaceto the second surface. The second through hole for receiving a tool ispositioned adjacent the first through hole and extends along a secondhole axis from the first surface to the second surface. The throughholes arranged so that the first hole axis is divergent with respect tothe second hole axis.

The aiming plate may feature an attachment mechanism attachable to theimplant in a first configuration in which a first surface faces theimplant and in a second configuration in which a second surface facesthe implant. The aiming plate may feature a first through hole forreceiving a tool, which may extend along a first hole axis from thefirst surface to the second surface. The aiming plate may also feature asecond through hole for receiving a tool, which may extend along asecond hole axis from the first surface to the second surface. When animplant is coupled to the aiming plate in the first configuration, thefirst hole axis may be directed towards a desired target feature on theimplant and the second hole axis may be directed away from the desiredtarget feature. When an implant is coupled to the aiming plate in thesecond configuration, the second hole axis may be directed towards adesired target feature on the implant and the first hole axis may bedirected away from the desired target feature.

The first through hole may be open to the second through hole. One orboth of the first and second surfaces may feature a compound openingdefined by an overlap between a first opening into the first throughhole and a second opening into to the second through hole.

The aiming plate may also feature third and fourth through holes. Thethird through hole may be for receiving a tool and may extend along athird hole axis from the first surface to the second surface. The fourththrough hole may be for receiving a tool and may extend along a fourthhole axis from the first surface to the second surface. When an implantis coupled to the aiming plate in the first configuration, the thirdthrough hole axis is directed towards a second desired target feature onthe implant and the fourth hole axis is directed away from the seconddesired target feature. When an implant is coupled to the aiming platein the second configuration, the fourth hole axis may be directedtowards a second desired target feature on the implant and the thirdhole axis is directed away from the second desired target feature. Thefirst and second desired target features may be located in differentregions of the implant. For example, where the implant is a proximalnail, the first desired target feature may be a locking hole in aproximal end region and the second desired target feature may be alocking hole in a distal end region.

The aiming plate may feature a first marking on the second surface, thefirst marking may indicate a type of implant having the desired targetfeature towards which the first through hole is directed in the firstconfiguration. The aiming plate may feature a second marking on thefirst surface, the second marking indicating a type of implant havingthe desired target feature towards which the second through hole isdirected in the second configuration.

Some advantages of the aiming device according to the invention arethat:

-   -   the aiming device comprises a single aiming plate with the        guiding holes for the left side configuration of the        intramedullary nail integrated from one side and the guiding        holes for the right side configuration integrated from the        opposite side of the aiming plate wherein the guiding holes of        the left and right side cross each other in such a manner that        inserting the guide sleeves or drill bushings into the wrong        hole would result therein that the guide sleeve or drill bushing        is directed far beside the intramedullary nail, even missing the        patient's shoulder. Therefore, if the wrong hole is taken no        harm will result;    -   in case of a universal intramedullary nail with only one        configuration for the left side or the right side bone but with        different locking holes to be used when the nail is used for the        left respectively the right side a surgeon can be prevented form        drilling a wrong hole into the bone; and    -   each side of the aiming plate can be largely labelled “LEFT” or        RIGHT”. During surgery the surgeon only once has to mount the        corresponding side correctly, and only the correct through holes        can be used for targeting the nail.

In an exemplary embodiment of the aiming device, the first through holeand the second through hole penetrate each other and form a compoundopening. The compound opening prevents the surgeon from searching asuitable through hole, the surgeon needs only to decide into whichthrough hole of the selected compound opening the drilling bushing is tobe inserted.

In a further exemplary embodiment of the aiming device, the aiming platecomprises a first set including more than one first through holes and asecond set including more than one second through holes.

In another exemplary embodiment of the aiming device, the aiming platefurther comprises a lower end and a central plane extending between theupper end and the lower end and cutting the left and right side whereinthe first and second hole axes of the first and second through holes ofat least one compound opening are located in one plane orthogonal to thecentral plane. This configuration allows the advantage that identicallypositioned anterior and posterior locking holes in the intramedullarynail can be used in left side and right side intramedullary nails.

In yet another exemplary embodiment of the aiming device, the first andsecond hole axis of the first and second through hole of at least onecompound opening is located in different planes orthogonal to thecentral plane and at different distances from the upper end of theaiming plate. Thus, a particular compound opening including first andsecond through holes can be arranged in the position of the problematiclocking holes of a universal intramedullary nail so that a surgeon isprevented from drilling a hole into the bone coaxially with a lockinghole which is problematic for anatomical reasons.

In a further exemplary embodiment of the aiming device, the aiming platecomprises a middle plane orthogonal to the central plane and at an equaldistance from the left side and from the right side of the aiming plateand wherein the first and second hole axis of the first and secondthrough hole of at least one compound opening cut the middle plane at anequal distance E from the central plane.

In yet a further exemplary embodiment of the aiming device, the firstand second hole axis of the first and second through hole of at leastone compound opening define a plane which is orthogonal to the centralplane and orthogonal to the middle plane.

In still a further exemplary embodiment of the aiming device, the firsthole axes of at least two first through holes and/or the second holeaxes of at least two second through holes are not arranged in the sameplane orthogonal to the central plane.

In another exemplary embodiment of the aiming device, the first holeaxis of the first through hole converges towards the central plane inthe direction from the left side towards the right side. By this meansthe advantage can be achieved that the surgeon can visually checkwhether the aiming plate has been correctly fixed to the intramedullarynail.

In yet another exemplary embodiment of the aiming device, the secondhole axis of the second through hole diverges from the central plane inthe direction from the left side towards side right side. Thus, thesurgeon will visually notice at once that the aiming guide has beenwrongly mounted to the intramedullary nail.

In a further exemplary embodiment of the aiming device, the first holeaxis of the first through hole encloses an angle α with the centralplane at a minimum of 5°, preferably a minimum of 15°. By this means theadvantage is achieved that a sufficient angle between the inserteddrilling bushings and the central plane permits a user to check whetherthe aiming plate is correctly fixed to the intramedullary nail. Further,the first hole axes of the first set of through holes can enclose anangle α with the central plane at a maximum of 70°, preferably a maximumof 45°. A typical value for the angle α is, for example, 30°.

In yet a further exemplary embodiment of the aiming device, the secondhole axis of the second through hole encloses an angle β with thecentral plane of minimum 5°, preferably minimum 15°. This configurationallows the advantage that on the one hand identically positioned lockingholes in the intramedullary nail can be used in a left side and a rightside intramedullary nail and on the other hand the prolongations of thesecond hole axes extend beside the intramedullary nail and even besidethe bone where the nail is inserted so unambiguously indicating to thesurgeon that the aiming guide is wrongly fixed to the intramedullarynail.

In still a further exemplary embodiment of the aiming device, the aimingplate comprises an additional compound opening of a left side throughhole with a left side hole axis and a right side through hole with aright side hole axis wherein the left side hole axis and the right sidehole axis are located in the central plane and diverge relative to eachother in the direction from the left side towards the right side. Theleft side hole axis and the right side hole axis lie in or are parallelto the central plane. The left side hole axis and the right side holeaxis can enclose an angle γ at a minimum of 10°, preferably a minimum of20°. Further, The left side hole axis and the right side hole axis canenclose an angle γ at a maximum of 140°, preferably a maximum of 90°.

In another exemplary embodiment, the aiming device further comprises anaiming arm with a first end including a first joining means and a secondend including a second joining means and wherein the first joining meansis attachable to the aiming plate and the second joining means isattachable to an intramedullary nail allowing to reversibly fix theaiming plate to an intramedullary nail in an aligned left position andin an aligned right position.

In yet another exemplary embodiment of the aiming device, the aimingplate comprises a third joining means engageable with the first joiningmeans at the aiming arm in an aligned left position and in an alignedright position.

In another exemplary embodiment, the aiming arm has a length allowing toreversibly fix the aiming plate with the middle plane at a distance A>0from a nail axis of an intramedullary nail. In case of an intramedullarynail suitable for a fixation of a fracture of the radius the distance Ais a minimum of 15 mm, preferably a minimum of 50 mm and a maximum of200 mm, preferably a maximum of 180 mm.

In a further exemplary embodiment, the aiming device further comprisesat least one drilling bushing with a front end and a rear end. Theprolongation of the second hole axis can be at a distance B of minimum10 mm, preferably minimum 30 mm from the central plane measured at thefront end of the drilling bushing when inserted in one of the secondthrough holes of the second set.

In an exemplary embodiment, the aiming device can consist of a carbonfibre reinforced PEEK, aluminum or stainless steel.

In accordance with a second aspect of the present invention, the aimingplate may be for orienting tools toward target features of anintramedullary nail, comprising an attachment mechanism at a proximalend of the aiming plate configured for attachment to a proximal end ofan intramedullary nail in first a configuration in which a first surfaceof the aiming plate faces a nail to which it is coupled and in a secondconfiguration in which a second surface of the aiming plate faces a nailto which it is coupled and a first compound opening extending throughthe aiming plate from the first surface to the second surface, the firstcompound opening including first and second through holes open to oneanother, the first through hole extending along a first hole axisconfigured to align with a corresponding locking hole in a nail coupledto the plate in the first configuration, the second through holeextending along a second hole axis configured to align with acorresponding locking hole in a nail coupled to the aiming plate in thesecond configuration, the first and second through holes being sized andshaped to receive a drill bushing therethrough and wherein, the firstand second hole axes intersect one another such the first hole axis doesnot align with any portion of a nail coupled to the aiming plate in thesecond configuration and the second hole axis does not align with anyportion of a nail coupled to the aiming plate in the firstconfiguration.

In accordance with another aspect of the present invention, a system isprovided for drilling the holes in a bone for inserting locking screwsin an intramedullary nail by using the intramedullary nail aimingdevice, the system comprising an intramedullary nail aiming deviceaccording to the first or second aspect of the invention and anintramedullary nail with a nail axis.

In an exemplary embodiment of the system, the intramedullary nailcomprises a fourth joining means engageable with the second joiningmeans of the aiming arm for reversibly fixing the aiming arm to theintramedullary nail in an aligned position.

In a further exemplary embodiment of the system, the aiming arm has alength allowing to reversibly fix the aiming plate with the middle planeat a distance A of minimum 70 mm, preferably minimum 50 mm from the nailaxis of the intramedullary nail.

In another exemplary embodiment of the system, the aiming arm isconfigured in such a manner that the nail axis extends parallel to themiddle plane when the aiming device is fixed to the intramedullary nail.

In accordance with another aspect, a method is provided for aligning athrough hole for receiving a tool with a desired feature of an implant.The method comprising the steps of:

-   -   a) identifiying a type of implant to be coupled to an aiming        plate;    -   b) determining a correct configuration of an aiming plate        according to the identified implant type; and    -   c) coupling the aiming plate to an implant of the identified        implant type in the determined correct configuration;

Once the correct configuration is determined the aiming plate may bepositioned in one of two configurations. In a first configuration, afirst through hole of the aiming plate is directed towards a firsttarget feature on a first implant type and a second through hole of theaiming plate is directed away from the first target feature. In a secondconfiguration, the second through hole is directed towards a secondtarget feature on a second implant type and the first through hole isdirected away from the second target feature.

The method may also have a step of determining by comparing theidentified implant type to a marking on the aiming plate to determinewhether to couple the aiming plate in the first or in the secondconfiguration.

The method may also have the step of recognising that the same implanttype is usable as a first implant type in the first configuration and asecond implant type in the second configuration. The step of determiningmay further have a step of identifying whether an implant is to be usedin a left hand configuration or a right hand configuration, where thefirst target feature may be different to the second target feature onthe implant.

In accordance with another aspect, a method is provided for drilling theholes in a bone for inserting locking screws in a left side or in aright side intramedullary nail by using the intramedullary nail aimingdevice. The method comprises the steps of:

a) positioning the left side or the right side of the aiming plate withrespect to the intramedullary nail according to which of the left sideor right side configuration of the intramedullary nail is to be usedduring the surgical procedure;b) fixing the aiming plate to the intramedullary nail;c) inserting at least one drilling bushing into one of the through holesof the first or second set;d) checking whether the drilling bushing has been inserted in a correctthrough hole of the first set in case of a left side nail or in acorrect through hole of the second set in case of a right side nail, and

if the drilling bushing has been inserted in a wrong through hole of thesecond set in case of a left side nail or a wrong through hole of thefirst set in case of a right side nail;

-   -   inserting the drilling bushing into the other through hole of        the first respectively second set; and    -   repeating step d);        or

if the drilling bushing has been inserted in a correct through hole ofthe first set in case of a left side nail or in a correct through holeof the second set in case of a right side nail, then:

e) drilling at least one hole in a bone where the intramedullary nail isinserted by using the drilling bushing for guiding a drill bit.

In an exemplary embodiment the method further comprises the step ofinserting a fixation screw through the drilling bushing.

In accordance with another aspect of the present invention, a method isprovided for drilling the holes in a bone for inserting locking screwsin a universal nail having only one configuration for the left and rightside bone but having two locking bores or two sets of locking bores, onewhen implanted in a left side bone and another when implanted in a rightside bone. The method comprises the steps of:

i) positioning the left side or the right side of the aiming plate withrespect to the intramedullary nail according to which of the left sideor right side bone is to be treated during the surgical procedure;ii) fixing the aiming plate to the intramedullary nail;iii) inserting at least one drilling bushing into one of the throughholes of the first or second set;iv) checking whether the drilling bushing has been inserted in a correctthrough hole of the first set in case of using the universal nail at aleft side bone or in a correct through hole of the second set in case ofusing the universal nail at a right side bone, and

if the drilling bushing has been inserted in a wrong through hole of thesecond set in case of using the universal nail at a left side bone or ina wrong through hole of the first set in case of using the universalnail at a right side bone;

-   -   inserting the drilling bushing into the other through hole of        the first respectively second set;        or

if the drilling bushing has been inserted in a correct through hole ofthe first set in case of using the universal nail at a left side bone orin a correct through hole of the second set in case of using theuniversal nail at a right side bone:

v) drilling at least one hole in a bone where the intramedullary nail isinserted by using the drilling bushing for guiding a drill bit.

BRIEF DESCRIPTION OF THE DRAWINGS

A plurality of embodiments of the invention will be described in thefollowing by way of example and with reference to the accompanyingdrawings in which:

FIG. 1 illustrates a perspective view of an embodiment of the aimingdevice according to the invention;

FIG. 2 illustrates a perspective view of the embodiment of FIG. 1 withthe drilling bushings inserted in the wrong through holes;

FIG. 3 illustrates a perspective view of another embodiment of theaiming device according to the invention in case of an application atthe left side humerus;

FIG. 4 illustrates a perspective view of the embodiment of FIG. 3 incase of an application at the right side humerus; and

FIG. 5 illustrates a perspective view of the embodiment of FIG. 4 withone drill bushing inserted in a wrong hole.

DETAILED DESCRIPTION

FIGS. 1 and 2 illustrate an embodiment of the intramedullary nail aimingdevice 1 used with a left side and a right side configuration of anintramedullary nail 8, wherein the intramedullary nail aiming device 1comprises an aiming plate 2 with a first surface 5, a second surface 6,a distal end 12 and a proximal end 7 attachable to an aiming arm 9 whichis fixed to an intramedullary nail 8. In a left side configuration, thefirst surface 5 faces away from the bone while the second surface 6faces toward the bone. In a right side configuration, the first surface5 faces toward the bone while the second surface 6 faces away from thebone. The aiming plate 2 further includes a plurality of compoundopenings extending through the aiming plate 2 from the first surface 5to the second surface 6. In a preferred embodiment, the aiming plate 2includes four compound openings. However, as would be understood bythose skilled in the art, any number of compound openings depending onthe characteristics of the intramedullary nails to be used with theaiming plate. Each compound opening comprises a first through hole 3 anda second through hole 13 which are open to one another. The firstthrough holes 3 form a first set of four first through holes 3 and thesecond through holes 13 form a second set of four second through holes13.

The aiming plate 2 comprises a longitudinal central plate portion 29extending along a longitudinal axis 15, a first lateral side surface 41and a second lateral side surface 42. Furthermore, the aiming plate 2includes two parallel first arms 43 protruding laterally from the firstlateral side surface 41 of the central plate portion 29 and two parallelsecond arms 44 protruding laterally from the second lateral side surface42 of the central plate portion 29. The first arms 43 and the secondarms 44 are staggered along the longitudinal axis 15 and have differentlengths. A central plane 11 extending between the proximal end 7 and thedistal end 12 and cutting the first and second surfaces 5, 6 issubstantially perpendicular to the first and second surfaces 5,6.Additionally, a middle plane 28 orthogonal to the central plane 11extends through the aiming plate 2 substantially parallel to the firstand second surfaces 5,6. Each first through hole 3 defines a first holeaxis 10 and each second through hole 13 defines a second hole axis 14,wherein the first and second through holes 3, 13 of each compoundopening are arranged in such a way that the first hole axis 10 and thesecond hole axis 14 intersect one another along the middle plane 28. Inthe present embodiment the first and second hole axes 10, 14 of thefirst and second through holes 3, 13 of each compound opening intersectone another along the middle plane 28 at an equal distance E from thecentral plane 11. The first and second hole axes 10, 14 of the first andsecond through holes 3, 13 of each compound opening define a planeorthogonal to the middle plane 28 and orthogonal to the central plane11. Further, the four compound openings are arranged so that the firstand second hole axes 10, 14 of each of the first and second throughholes 3, 13 of one compound opening define a different plane orthogonalto the middle plane 28 and orthogonal to the central plane 11.

The first through holes 3 are sized and shaped to receive a drillbushing 4 and/or drill bit from the first surface 5 along the centralaxis 10 aligned with a corresponding locking hole (not shown) in a leftside configuration intramedullary nail 8 coupled to the aiming plate 2.The second through holes 13 are sized and shaped to receive a drillbushing 4 and/or drill bit from the second surface 6 along the centralaxis 14 aligned with a corresponding locking hole in a right sideconfiguration intramedullary nail 8 coupled to the aiming plate 2. Thefirst hole axes 10 of the first through holes 3 converge toward thecentral plane 11 in a direction from the first surface 5 toward thesecond surface 6 while the second hole axes 14 of the second throughholes 13 diverge from the central plane 11 in the direction from thefirst surface 5 toward the second surface 6. Thus, each first hole axis10 of the first through holes 3 forms an angle α_(i) with the centralplane 11 while each second hole axis 14 of the second through holes 13forms an angle β_(i) with the central plane 11. The present embodimentmay comprise four compound openings such that i=1 to 4. If identicallypositioned anterior and posterior locking holes in the intramedullarynail 8 are used in left side and right side intramedullary nails 8, theangle β_(i)=α_(i) for the first and second through holes 3, 13 of eachcompound opening.

The aiming plate 2 may further comprise an additional compound openingthrough the central portion 29 of the aiming plate. The additionalcompound opening includes first and second through holes 16, 18. A firstcentral axis of the 17 of the first through hole 16 corresponds to alocking hole of a left side configuration intramedullary nail 8 while asecond central axis 19 of the second through hole corresponds to alocking hole of a right side configuration intramedullary nail 8. Thus,a drill bushing 4 should be inserted through the first through hole 16along the first central axis 17 from the first surface 5 to the secondsurface 6 and through the second through hole 18 along the secondcentral axis 19 from the second surface 6 to the first surface 5. Thefirst central axis 17 and the second central axis 19 lie in the centralplane 11 and diverge relative to each other in the direction from thefirst surface 5 towards the second surface 6. Measured in the centralplane 11 the first central axis 17 and the second central axis 19 of theadditional compound opening form an angle γ.

The intramedullary nail aiming device 1 may further comprises an aimingarm 9 which may be attached to the proximal end of the intramedullarynail 8. The aiming arm 9 has a first end 20 including a first joiningmechanism 24 and a second end 21 including a second joining mechanism25. The first joining mechanism 24 of the aiming arm 9 may be coupled toa third joining mechanism of the aiming plate 2. The first joiningmechanism 24 comprises two pins 45, axes of which lie in the centralplane 11 and are spaced apart from one another. The third joiningmechanism 26 may include bores 46 at a proximal end 7 of the aimingplate 2 for receiving the pins 45 of the first joining mechanism 24therethrough. Further, the first joining mechanism 24 includes a screw47 penetrating a respective hole (not shown) in the aiming plate 2 toreleasably couple the aiming plate 2 to the aiming arm 9. The secondjoining mechanism 25 of the aiming arm 9 comprises two further pins 49and a fastener 48 for releasably coupling the aiming arm 9 to theintramedullary nail 8. The intramedullary nail 8 comprises a fourthjoining mechanism 27 including, for example, two lateral holes and acoaxial hole engageable with the second joining mechanism 25 of theaiming arm 9 to allow the releasable coupling of the aiming arm 9 to theintramedullary nail 8 in an aligned position.

As illustrated in FIG. 2, if a drill bushing 4 is inadvertently insertedthrough the second through holes 13 from the first surface 5 past thesecond surface 6, while in the aiming plate 2 is in the left sideconfiguration, the drill bushing 4 would not be aligned with any portionof the intramedullary nail 8. Similarly, a drill bushing 4 wronglyinserted into the second through hole 18 of the additional compoundopening from the first surface 5 to the second surface 6 would not alignwith a locking hole of the intramedullary nail 8 and would immediatelybe recognized as incorrect since the angle γ has a value that can bereadily recognized as such.

The embodiment of the intramedullary nail aiming device 1 according toFIGS. 1 and 2 is used with a left side or a right side configuration ofan intramedullary nail 8. The method for drilling holes in a bonecoaxially to the locking holes of the intramedullary nail 8 comprisesthe steps of:

-   1) positioning the aiming plate in the left or right side    configuration depending on whether it is to be used with a right    side or left side configuration intramedullary nail 8. In the left    side configuration, the first surface 5 faces away from the bone    while the second surface 6 faces the bone. In the right side    configuration, the first surface 5 faces the bone and the second    surface 6 faces away from the bone. The aiming plate 2 is then    coupled to the intramedullary nail 8 via, for example, the aiming    arm 9.-   2) inserting a drilling bushing 4 through one of the through holes    3, 13 of the compound opening. When the aiming plate 2 is in the    left side configuration, the drilling bushing 4 is inserted through    the first through hole 3 and when the aiming plate 2 is in the right    side configuration, the drill bushing is inserted through the second    through hole 13.-   3) checking whether the drilling bushing 4 has been inserted through    a correct one of the first and second through holes 3, 13 (e.g.,    through the first through hole 3 in the case of a left side    intramedullary nail 8 or through the second hole 13 in the case of a    right side intramedullary nail 8). When the drilling bushing 4 has    been inserted in a wrong one of the through holes 3, 13 (e.g.,    through the second through hole 13 in the case of a left side    intramedullary nail 8 or through a first through hole 3 in the case    of a right side intramedullary nail 8), inserting the drilling    bushing 4 into the other of the through holes 3, 13 and repeating    step 3); and-   4) when the drilling bushing 4 has been inserted in a correct one of    the through holes 3, 13, drilling at least one hole in a bone into    which the intramedullary nail 8 has been inserted using the drilling    bushing 4 for guiding a drill bit.

Alternatively, the above steps 2)-4) can be performed for each of thefirst or second through holes 3, 13 separately and repeated for therespective number of first or second through holes 3, 13 to be appliedin the procedure.

FIGS. 3 to 5 show another embodiment of the aiming device 1 mounted toan intramedullary nail 8 configured as a universal intramedullary nail 8with only one configuration for both left side and right side bones.Depending on the application of the universal intramedullary nail 8 forthe left side or the right side bone, the locking of the intramedullarynail 8 in the bone does not necessarily include insertion of a lockingscrew 40 in every one of the proximal and distal locking holes 31, 32 ofthe intramedullary nail 8. In some cases (for anatomical reasons) one ormore of the proximal and distal locking holes 31, 32 of theintramedullary nail 8 will not be used for insertion of a locking screw40. For example, when inserting a universal intramedullary nail 8 intothe proximal humerus, a locking screw 40 is often not inserted into themost anterior proximal locking hole 33 (FIGS. 3 and 5) because it mightpenetrate the biceps tendon. When using a universal intramedullary nail8 on the left side humerus (FIG. 3) the second locking screw 40 from theproximal end 35 of the universal intramedullary nail 8 may beproblematic. Similarly, when inserting a universal intramedullary nail 8in the right side humerus (FIGS. 4 and 5), the third locking screw 40from the proximal end 35 of the universal intramedullary nail 8 may beproblematic (FIG. 5).

The embodiment of the intramedullary nail aiming device 1 illustrated inFIGS. 3 to 5 differs from the embodiment of FIGS. 1 and 2 only in thatthe aiming plate 2 includes only one arm 44 protruding from the secondlateral side 42 and the aiming plate 2 comprises only one compoundopening including a first through hole 3 with a first hole axis 10 and asecond through hole 13 with a second hole axis 14. Additionally, theaiming plate 2 includes a number of central through holes 50 extendingthrough the central portion 29 of the aiming plate 2 at differentdistances from the proximal end 7 of the aiming plate 2. The centralthrough holes 50 have hole axes lying in the central plane 11 andextending orthogonally to the middle plane 28. Thus, locking screws 40inserted into the proximal locking holes 31 extend parallel to thefrontal plane of the patient. The first and second through holes 3, 13are arranged in the arm 44. Further, the first and second hole axes 10,14 of the first and second through holes 3, 13 of the compound openingare arranged in different planes orthogonal to the middle plane 28 andorthogonal to the central plane 11. Therefore, in the embodiment of theaiming plate 2 of FIGS. 3 to 5 the first and second hole axes 10, 14 areskew lines. The first through hole 3 is suitable for receiving a drillbushing 4 from the left side 5 in a predetermined direction coincidingwith the corresponding third locking hole 31 from the proximal end 35 ofthe universal intramedullary nail 8 (FIG. 3). The second through hole 13is suitable for receiving a drill bushing 4 from the right side 6 (FIG.4) in a predetermined direction coinciding with the corresponding secondlocking hole 31 of the universal intramedullary nail 8. As illustratedin FIG. 5, if the drill bushing 4 is inserted through the first throughhole 3 from the second surface 6 to the first surface 5, the drillbushing is not aligned with any portion of the intramedullary nail 8 sothat the surgeon realizes at one glance that the drill bushing 4 isinserted in the wrong hole.

The embodiment of the intramedullary nail aiming device 1 shown in FIGS.3 to 5 is configured for use with a universal intramedullary nail 8having only one configuration for both left and right side bones. Themethod for drilling holes in a bone coaxially to the desired lockingholes 31, 32 of the intramedullary nail 8 comprises the steps of:

-   -   1) positioning the aiming plate 2 in the left or right side        configuration depending on whether intramedullary nail 8 is        being used to treat a left side or a right bone and fixing the        aiming plate 2 to the intramedullary nail 8;    -   2) inserting a drilling bushing 4 into one of the first and        second through holes 3, 13;    -   3) checking whether the drilling bushing 4 has been inserted in        a correct through hole 3, 13 (i.e., the first through hole 3        when the universal nail is inserted in a left side bone or in a        second through hole 13 when the universal nail is inserted in a        right side bone). If the drilling bushing 4 has been wrongly        inserted in the second through hole 13 in case of a left side        bone or wrongly in the first through hole 3 in case of a right        side bone, the drilling bushing 4 is inserted into the other        through hole 3, 13 of the first respectively second through        holes 3, 13. If the drilling bushing 4 has been correctly        inserted in the first through hole 3 in case of using a left        side bone or correctly inserted in the second through hole 13 in        case of a right side bone, the user drills at least one hole in        a bone into which the intramedullary nail 8 has been inserted        using the drilling bushing 4 to guide the drill bit.

The embodiment of the intramedullary nail aiming device 1 shown in FIGS.1 to 5, is aligned with the intramedullary nail to ensure that a correctthrough hole for receiving a tool is aligned with a desired feature ofan implant. To achieve this alignment, a method can be used, which hasthe steps of:

-   -   a) identifying a type of implant to be coupled to an aiming        plate;    -   b) determining a correct configuration of an aiming plate        according to the identified implant type; and    -   c) coupling the aiming plate to an implant of the identified        implant type in the determined correct configuration;

The determined correct configuration is one of the left sideconfiguration or right hand side configuration described previously. Thesame applies for the universal intramedullary nail shown in FIGS. 3 to5. Markings “LEFT” and “RIGHT” on opposed surfaces of the aiming plate 1are also used to determine the correct configuration. That is, themarking “LEFT” indicates the surface a user should see when the othersurface is facing towards the nail in the left side configuration, andthe marking “RIGHT” indicates the surface a user should see when theother surface is facing towards the nail in the right sideconfiguration.

Although the invention and its advantages have been described in detail,it should be understood that various changes, substitutions, andalterations may be made herein without departing from the spirit andscope of the invention as defined by the appended claims. Moreover, thescope of the present application is not intended to be limited to theparticular embodiments of the process, machine, manufacture, compositionof matter, means, methods and steps described in the specification. Asone of ordinary skill in the art will readily appreciate from thedisclosure of the present invention, processes, machines, manufacture,composition of matter, means, methods, or steps, presently existing orlater to be developed that perform substantially the same function orachieve substantially the same result as the corresponding embodimentsdescribed herein may be utilized according to the present invention.

It will be appreciated by those skilled in the art that variousmodifications and alterations of the invention can be made withoutdeparting from the broad scope of the appended claims. Some of thesehave been discussed above and others will be apparent to those skilledin the art.

1-12. (canceled)
 13. An aiming system for orienting tools toward targetfeatures of an implant, comprising: an implant extending longitudinallyfrom a proximal end to a distal end and including a first set of targetfeatures; an aiming plate comprising: a reversible attachment mechanism,a first surface and a second surface, a first through hole for receivinga tool, the first through hole extending along a first hole axis fromthe first surface to the second surface, and a second through hole forreceiving a tool, the second through hole extending along a second holeaxis from the first surface to the second surface; and an aiming arm forattaching the aiming plate to the implant, the aiming arm extending froma first end including a first joining mechanism engageable with theproximal end of the implant and a second end including a second joiningmechanism engageable with the reversible attachment mechanism; wherein,in a first configuration, the aiming arm is engaged with the reversibleattachment mechanism to orientate the first through hole to direct atool towards a desired target feature on the implant and the secondthrough hole is arranged to direct a tool away from the desired targetfeature and, in a second configuration, the aiming arm is engaged withthe reversible attachment mechanism to orientate the second through holeto direct a tool towards a desired target feature on the implant and thefirst through hole is arranged to direct a tool away from the desiredtarget feature.
 14. The system of claim 11, further comprising adrilling bushing extending from a first end to a second end, the drillbushing positionable in a through hole.
 15. The system of claim 11,wherein the intramedullary nail includes a fourth joining mechanismengageable with the second joining mechanism of the aiming arm toreleasably attach the aiming arm to the intramedullary nail.
 16. Thesystem of claim 11, wherein the aiming arm is configured such that, whenthe aiming plate and the implant are engaged with the aiming arm, alongitudinal axis of the implant is substantially parallel to the firstand second surfaces of the aiming plate.
 17. A method of aligning athrough hole for receiving a tool with a desired feature of an implant,the method comprising the steps of: a) identifying a type of implant tobe coupled to an aiming plate; b) determining a correct configuration ofan aiming plate according to the identified implant type; and c)coupling the aiming plate to an implant of the identified implant typein the determined correct configuration; wherein the determined correctconfiguration is one of: a first configuration in which a first throughhole is directed towards a first target feature on a first implant typeand a second through hole is directed away from the first targetfeature, and a second configuration in which the second through hole isdirected towards a second target feature on a second implant type andthe first through hole is directed away from the second target feature.18. The method of claim 15, wherein the step of determining furthercomprises comparing the identified implant type to a marking on theaiming plate to determine whether to couple the aiming plate in thefirst or in the second configuration.
 19. The method of claim 15,wherein when the first and second implant types are the same implanttype, the step of determining further comprises the step of identifyingwhether an implant is to be used in a left hand configuration or a righthand configuration; and wherein the first target feature is different tothe second target feature on the implant.